Once wet AMD has been diagnosed then the earlier treatment is given the better the prognosis for good vision.
Treatment, therefore, should be given as soon as possible after any symptoms occur.
Laser treatment to destroy the new small blood vessels under the macula have been used in the past and is still occasionally used.
The treatment for wet age related macular degeneration today, however, generally involves injecting drugs known as anti-VEGF agents into the eye.
The procedure is known as an IntraVitreal Injection.
Although this may sound painful it is a relatively simple procedure and should be painless.
The procedure involves the patients lying down. The eye and skin area are disinfected. A small drape is put over the eye and a speculum inserted to keep your eyelids open.
The eye is anaesthetized with drops.
You may feel a little pressure during the injection but it should not be painful.
Immediately following the injection you may notice a few floaters in the eye but these should settle within a short period.
The injections may be required every month for several years to the eye but this can depend on the results of the OCT macular scan that will be performed.
Ophthalmologists have a choice of two antiVEGF agents for the treatment of wet AMD, following NICE guidance on Ranibizumab(Lucentis) (TA155) and Aflibercept(eylea) (TA294).
Most patients will respond to treatment.
Some patients do not have an adequate response to the initial anti-VEGF agent and some patients may not respond at all.
Lucentis and Eylea are licensed for the treatment of neovascular wet age related macular degeneration.
Bevacizumab(Avastin) is a licensed drug that has been used in age related macular degeneration.
It is however not licensed for this treatment and is therefore used ‘off label’.
It has been used regularly and frequently throughout the world.
A working group of the Scientific Committee of the Royal College of Ophthalmologists has considered the published literature relating to the efficacy and safety of bevacizumab (Avastin) and ranibizumab (Lucentis) in the treatment of the neovascular (‘wet’) form of age-related macular degeneration (AMD). The College view is that the current published literature is consistent with the conclusion that bevacizumab and ranibizumab are equally effective in the treatment of neovascular age-related macular degeneration and there is no convincing evidence of a clinically significant difference in the incidence of serious adverse events between the two groups.
As with any treatments there are always risks and complications.
The following complications have been identified in the literature but these are rare and are mentioned for completeness of your informed consent.
The incidence ranges from 0.02 – 1.6%
Endophthalmitis can cause permanent loss of vision and complete loss of vision in the eye. Should you notice any sign of visual disturbance or ocular pain you should contact the clinic immediately.
Intraocular inflammation is one of the main ocular adverse events associated with IVI. This can range from 1.4 – 2.9%. Can cause significant loss of vision.
It is difficult to differentiate sterile intraocular inflammation from infectious endophthalmitis.
The incidence of rhegmatogenous retinal detachments after IVI is low (0 – 0.6%).
Retinal detachment can result in loss of vision and occasionally complete loss of vision.
This is common and can last a few hours at most.
Subconjunctival haemorrhage on the surface of the eye can occur in approximately 10% of injections. This is higher if you are taking aspirin or Warfarin equivalents. We do not recommend discontinuing your Warfarin prior to injection.
Anti-VEGF agents are used widely with systemic administration for other ocular diseases. There may be an increased risk following IVI of myocardial infarction (heart attack), stroke, hypertension, gastrointestinal perforation and kidney disease.
This can occur following IVI in advanced diabetic retinopathy leading to loss of vision
The incidence ranges from 0.06 – 27%. – leading to sudden decrease in vision.
Retinal vein occlusions – leading to reduced vision
Retinal artery occlusions – leading to reduced vision
Haemorrhagic macular infarction – leading to reduced vision
Cranial nerve palsy
Decrease in kidney function
Of course the alternative to not having the injections is that the macular degeneration will progress and your vision will almost inevitably deteriorate.
This deterioration can be quite rapid.